HHS Releases Policies to Make Coverage More Accessible and Expand Behavioral Health Care Access for Millions of Americans in 2024
The Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality health care options for millions of consumers. The proposed rule would increase access to health care services, simplify choice and improve the plan selection process, and reduce consumer barriers.
“The Biden-Harris Administration has taken historic action to expand access to health care, and the Affordable Care Act Marketplace provides millions of Americans vital coverage,” said HHS Secretary Xavier Becerra. “As we make a final push now during Open Enrollment, we are encouraged that so many people are signing up for Marketplace health plans. Already we are working to build on this success.”
“We know that access to affordable health care is a concern across the nation. During the first several weeks of Affordable Care Act Marketplace Open Enrollment, we have already seen 5.5 million people select a Marketplace health plan, an 18% increase compared to last year” said CMS Administrator Chiquita Brooks-LaSure. “Continuing to propose policies that help make it easier for consumers to choose and maintain the health coverage that best fits their needs is vital. If finalized, this proposed rule does just that.”
Increasing access to health care services
The Biden-Harris Administration has made expanding access to behavioral health care a top priority. As part of that effort, the proposed rule includes two new major essential community provider (ECP) categories that are critical to delivering needed behavioral health care: Substance Use Disorder Treatment Centers and Mental Health Facilities. The rule also furthers access to providers by including a proposal to extend the current overall 35% provider participation threshold to two major ECP categories: Federally Qualified Health Centers and Family Planning Providers. These changes, in conjunction with a proposal to expand Network Adequacy requirements, would increase provider choice, advance health equity, and expand access to care for consumers who have low income, complex or chronic health care conditions, and/or who reside in underserved areas, as these consumers are often disproportionately affected by unanticipated costs associated with provider network status and limited access to providers.
Simplifying choice and improving the plan selection process
In response to public feedback, the rule includes proposals to make it easier for consumers to pick a health plan that best fits their needs and budget by updating designs for standardized plan options and limiting the number of non-standardized plan options offered by qualified health plans (QHPs) through the Federally-facilitated Marketplaces (FFMs) and State-based Marketplaces on the Federal Platform (SBM-FPs). The average number of plans available to consumers on the Marketplace has increased from 27.1 in PY2019 to 131.4 in PY2023. Having too many plans to choose from can limit consumers’ ability to make a meaningful selection when comparing plan offerings. Streamlining the plan selection process would make it easier for consumers to evaluate plan choices available on the Marketplaces and to select a health plan that best fits their unique health needs.
Making it easier to enroll in coverage
The proposed rule would give the Marketplaces the option to implement a special enrollment period for people losing Medicaid or Children’s Health Insurance Program (CHIP) coverage. This option would mean that consumers would have 60 days before, or 90 days after, their loss of Medicaid or CHIP coverage to select a Marketplace plan. CMS believes that this new proposed special rule would help mitigate coverage gaps when consumers lose Medicaid or CHIP while allowing for a more seamless transition into Marketplace coverage…
For more information on the proposed rule, consult the fact sheet.
To review the Notice of Benefit and Payment Parameters for 2024 Proposed Rule, visit the CMS website. The 45-day public comment period will begin once published in the Federal Register.
President's Message
Posted: December 13, 2022
First, thank you to VP Chris Chimenti for filling in for me in the last issue of House Calls. I appreciate his kind and thoughtful words as well as those that several other members shared upon the passing of my father.
Have you listened to Dr. Tim Dunn’s nearly hour-long interview with Cindy Krafft on “All Things OASIS” yet? It is amazing! Cindy approaches OASIS-E (and several other topics) with her usual wit and expertise, and we’ll be hearing a lot more from Dr. Dunn, our new OASIS program director, in the coming weeks as his training series rolls out. Watch for this series of online modules in January, along with more podcast interviews with industry leaders!
Finally, let’s all pause for a moment and remember Douglas Brant. Mr. Brant was a home health nurse in the Spokane, WA, area who was murdered on December 1 by a client’s family member during a visit. While the exact circumstances around this tragedy are unclear, the safety of all home health providers should be sacrosanct. Always pay attention to your surroundings, and always leave yourself a way out!
2023 APTA Home Health Award Nominations
The APTA Home Health Awards are presented annually to deserving individuals, recognized by peers and colleagues, at the Home Health Business Meeting during APTA's annual Combined Sections Meeting in February.
The Academy is now accepting nominations for the following awards through January 6, 2023 (EXTENDED). Please take a moment and consider an impactful individual to the home health practice worthy of recognition.
President’s Award: Recognizes a Home Health Academy member who has provided notable service to the Academy.
Emerging Leader in APTA Home Health: Recognizes and honors one Physical Therapist or Physical Therapist Assistant who has demonstrated extraordinary service and clinical passion early in his or her home health career. The individual should have made exceptional overall accomplishments and contributions to the APTA and/or the Home Health Academy mission and vision, and to the physical therapy profession to advance quality and evidenced‐based care in the home.
Excellence in Home Health Clinical Practice Award: Recognizes a physical therapist or physical therapist assistant for outstanding clinical practice in a home health care setting.
Excellence in Home Health Leadership Award: Recognizes the exceptional contribution of an APTA Home Health member in promoting home health physical therapy practice.
Dr. Carol Zehnacker Friend of the Academy Award:Acknowledges an individual, group or organization that has made an enduring contribution to the home health industry and that has been an advocate of the profession of physical therapy in the home, as is relates to clinical practice and/or regulations. This award is dedicated to the late Dr. Carol Zehnacker who passed away in November 2021. Dr. Zehnacker was a physical therapist and a member of the APTA for 56 years. She served our profession in many ways at both the state and national levels as a leader, mentor, and advocate. She served as the Federal Affairs Liaison and Government Affairs Committee Chair for the Home Health Academy. In this role she advocated fiercely against administrative burden and regulations that hamper PTs ability to provide quality care.
Preceptor Award: Acknowledges an individual that has been chosen by their agency/company to be a preceptor. This therapist demonstrates the unique qualities, high standards and clinical skills that are exemplary. They are organized and able to teach processes and procedures to newly hired staff, molding them into confident and talented home care clinicians.
To view awards criteria and to submit a nomination, click here.
U.S. Congress Could Punt Funding Bill into 2023, McConnell Says
WASHINGTON, Dec 6 (Reuters) - The U.S. Congress may be forced to delay until early 2023 final agreement on funding the government through the end of its fiscal year, instead relying on a stopgap measure to keep the lights on, the top Senate Republican said on Tuesday.
The federal government is currently set to run out of money on Dec. 16 without a vote on either an "omnibus" bill funding the government through Sept. 30, 2023, or a short-term bill known as a "continuing resolution," or CR.
"We're running out of time, and that may end up being the only option left that we could agree to pursue," Senate Republican leader Mitch McConnell told reporters a day after meeting his Democratic counterpart Chuck Schumer to discuss a comprehensive omnibus package.
"We don't have agreements to do virtually anything," McConnell said. "We don't even have an overall agreement on how much we want to spend."
An omnibus bill would be expected to exceed the $1.5 trillion funding package Congress approved last March. Senator Richard Shelby, the top Republican appropriator, said the two sides were about $25 billion apart, which he described as "pretty close."
McConnell spoke the day after House Republican leader Kevin McCarthy told Fox News negotiators should hold off until January, when the new Congress with a slim Republican majority in the House is sworn in.
A Republican congressional aide, who asked for anonymity to describe intra-party dynamics, said McCarthy's warning was meant to pressure Democrats to move forward on an omnibus deal. The aide added that McCarthy has privately backed a longer-term bill to avoid a funding stand-off early in 2023.
Schumer acknowledged that there was still "a lot of negotiating left to do" to get an omnibus bill.
"Leader McConnell and I have agreed to try and work together to make sure we get a year-long omnibus funding bill done. We hope it can be done this year," Schumer told reporters.
Updated Plan: Ask Congress to STOP the Cuts in the Year End Package
From the National Association for Home Care & Hospice
Following the finalization of the home health rule NAHC engaged with the sponsoring offices of the Preserving Access to Home Health Act (S. 4605/H.R. 8581) on refining the legislation to better its chances for passage before the end of the year, as well as strengthen transparency of CMS in their rate-setting. Our champions on Capitol Hill are working to substitute this amended language in the negotiations for the year-end package. This amendment will not be introduced as new legislation.
While there won't be a new bill to call for congressional action on, you can still advocate for this revised approach.
Please contact our Senators and Representatives requesting they support a year-long delay (2023) of the home health rate cut and call for added transparency in CMS rate-setting practices. The NAHC Legislative Action Center is set up and ready with this message.
If you will be writing your own message or speaking with your elected officials here are helpful talking points:
The Issue
The Centers for Medicare and Medicaid Services (CMS) issued a Final Rule on October 31, 2022, that reduces Medicare payments for home health services by $635 million in 2023 and triggers an estimated $18 billion in payment reductions over the next decade. Congressional action in 2018 required CMS to establish a new payment model that was "budget neutral," not one that cuts support for home health services by $18 billion.
The impact of those payment cuts would exacerbate the ongoing dismantling of this essential benefit that serves over 3 million of the most vulnerable Medicare beneficiaries, providing them with exceptional quality care in their own homes, preventing high-cost hospitalizations, and offering an alternative to life-changing institutional care while saving Medicare billions in spending every year.
Over the past decade, Medicare beneficiaries have experienced significant reductions in access to home health care that were not authorized or sanctioned by Congress.
In the last 10 years, Medicare beneficiaries using home health services has dropped from 3.5 million beneficiaries annually to 3.1 million beneficiaries as a result of continually reduced payment rates.
With the $635 million payment cut in 2023, the permanent rate reduction of 7.85% finalized by CMS, and over $2 billion in planned "clawback" cuts, future care access can only worsen further in the face of $18 billion in current and future payment cuts.
CMS has portrayed the recent action as an increase in Medicare spending on home health services, but that is highly misleading. The 2022 30-day national standardized payment rate is $2,031.64, yet CMS finalized the 2023 30-day national standardized payment rate at $2,010.69. This represents a reduction in year-over-year payment for care provided by home health agencies beginning in January, despite the significantly increased costs home health agencies continue to experience.
CMS has refused to provide the data and information necessary to replicate its calculations and fully assess the validity of its methodology.
Pending bipartisan legislation, the "Preserving Access to Home Health Act of 2022," S. 4605 and HR 8581, would suspend the behavioral adjustment rate cut to give Congress time to address the complex issues presented by the new payment model. A developing revision of this proposal would focus on suspending the payment cut for just 2023.
What Must be Done
Support stability in the home health care community in 2023 by suspending the entirety of the behavioral adjustment cut to the CY 2023 home health payment rate in CMS's CY 2023 Final Rule.
Strengthened disclosure, accountability, and transparency of the payment rate-setting method employed by CMS, including direct stakeholder engagement, to ensure a budget-neutral transition to the new payment system.
Thank you for helping us carry this unified message out to legislators. We ask that you implement and push for grassroots involvement to get this message out.
